Ectopic gallbladder lithiasis associated with white-line hernia: a rare association revealed by abdominal wall inflammation

Abstract

Unlike anatomical variant, which is a functional adaptive deviation, congenital anomaly can cause pathological symptoms or, at least, it can pose clinical or paraclinical challenges. Ectopic gallbladder can be isolated or associated with abnormal liver development including lobe with hypertrophy, supernumerary lobe, or agenesis of hepatic lobe. Gallbladder usually lies in the right hypochondrium, below the lower quadrant of the right hepatic lobe. However, it can lie in other sites such as the right flank, the epigastrium, the periumbilical region, the right iliac fossa and even the left hypochondrium in patients with abdominal situs inversus. Its association with white-line hernia has never been reported; this poses clinical challenges and lead to difficulties in surgical approach. We here report a rare case of ectopic epigastric gallbladder lithiasis associated with white-line hernia in a 65-year-old patient admitted in the Emergency Room with diffuse abdominal pain. Abdominal examination showed epigastric swelling with inflammatory signs (Figure A). Radiological assessment revealed ectopic gallbladder lithiasis (Figure B, C). The patient underwent midline laparoscopic cholecystectomy. The anatomopathological examination of the surgical specimen confirmed the diagnosis.